The Health Issue

The hospice at the California Medical Facility is one of the nation’s first.Katy Grannan for The New York Times

ThePrisonersWhoCarefortheDyingandGetAnotherChanceatLife

In a California prison hospice, inmates become caregivers to fellow convicts who will never make it out alive.

By SULEIKA JAOUADPhotographs by KATY GRANNANMAY 16, 2018

Inked in tattoos from neck to knuckle, Kevion Lyman rose from his bunk at dawn, pulled scrubs over his skinny frame, stepped out of his cell and set out for work. The 27-year-old strolled down the long central hallway connecting the different wings of the prison, past the dining hall, the solitary-confinement unit for violent offenders and the psych ward. Pushing open the big steel doors, he reported for his morning shift in the hospice.

Great efforts have been made to differentiate the hospice from the rest of the prison: The windows have white shutters, root-beer floats are occasionally served, the walls are plastered in artwork and a plastic tree, left over from Christmas with green-and-red tinsel looping through its branches, lights up the entrance. These attempts to add cheer go only so far, of course. Shutters open onto iron bars. Correctional officers escort nurses as they make rounds with a medication cart. Inmate workers are frisked at the start and the end of their shifts. And until recently, the only outdoor space available to patients was a small chain-link-fenced patio nicknamed “the dog run.” The California Medical Facility, a medium-security prison in Vacaville, midway between San Francisco and Sacramento, houses general-population inmates as well as those with health conditions and specialized medical needs. It is home to 2,400 men — some young and healthy, others disabled and sick, and then those in the hospice, who are dying.

Lamerrill Dawson watching TV in his hospice cell. Opening image: Kevion Lyman (right) helping to steady Ralph Martinez.Katy Grannan for The New York Times

Later that January morning, Lyman and two co-workers, Fernando Murillo and Kao Saephanh, smoothed clean sheets and a red, flowery quilt onto an empty bed. They were ushering in their newest patient: a lanky man clad in a navy jumpsuit named Jimmy Figueroa. Finding a spot on the edge of his new mattress, Figueroa held a carton of fortified milk, appearing dazed as he slurped on a straw through the large gap where his teeth had once been. With a deep tan, a full head of silvery-black hair elegantly parted in the middle and knockoff Ray-Ban sunglasses perched on the bridge of his nose, he looked, as one of the men observed, like an Italian hit man in a movie.

“I believe we’ve done business together,” he said to Saephanh.

“Oh, yeah?”

“I sold you some nuclear weapons a few years back. You’re Kim Jong-il,” said Figueroa, as though he were greeting an old colleague. He did not appear to be joking.

Kao Saephanh cutting Ernest Marin Jr.’s hair.Katy Grannan for The New York Times

Saephanh laughed, exchanging a raised eyebrow with his co-workers. Lyman, who stood to his right, was toting a welcome box filled with toiletries, flip-flops, a blue-and-white-pinstriped robe and a urine bottle for emergencies. He held the bin out to Figueroa. “Nice to meet you, Big Dog. That’s for you.”

“Religion?” Saephanh asked, filling out the intake sheet.

“I’ve got five religions.” Figueroa’s face brightened into a grin as he counted them on each of his fingertips — “Muslim, Catholic, Buddhist, Christian. ... ”

Martinez in the barber’s chair in the “dog run,” the hospice unit’s outdoor space.Katy Grannan for The New York Times

“I feel you. Me, too,” Lyman said, giving him a fist bump. “This is the TV, a’ight?” He pointed to the plastic monitor on the dresser, where Dr. Oz and Donald Trump were deep in conversation.

Murillo got down on one knee on the linoleum floor so that he was at eye level with the patient. He put tan socks on Figueroa’s feet, which dangled off the side of the bed, and gave them a squeeze. “We’re here for you — anything you need. Now, it’s time to get some rest.”

Michael Watkins, 35, helping an inmate in the bathroom.Katy Grannan for The New York Times

“I’ve got a big brain!” Figueroa exclaimed. “Did you know I’m a very important man? I’m the son of Hitler, and I work for the U.S. government on very important projects.”

Murillo placed a gloved hand on Figueroa’s shoulder and stood up to leave. “Even people with big brains need to rest.”

Jimmy Figueroa in the hospice ward’s bathroom.Katy Grannan for The New York Times

The hospice at the California Medical Facility is one of the nation’s first and the only licensed hospice unit inside a California prison. Built in 1993 in response to the AIDS crisis and inmate-led demands for more humane care, the hospice was originally populated with young men dying of complications of the disease. Today, the 17-bed unit is filled with a different demographic: graying men with everything from end-stage cancer to Alzheimer’s shuffle around with walkers, sit in wheelchairs watching television or lie curled up under heavy blankets.

Prisoners older than 55 serving time in federal and state prisons make up the fastest-growing age group behind bars, increasing more than 500 percent since the 1990s, from 26,300 aging inmates in 1993 to 164,800 at the end of 2016. Criminal-justice experts point to a mix of policies that landed us here: long sentences from get-tough-on-crime laws, a steady increase of older adults entering prison and challenges with the timely issuing of compassionate release and medical parole. One result is a different kind of death penalty for violent and nonviolent offenders alike. As one patient said to me when I first arrived at the hospice, “Welcome to death row.”

Most prisons were never built to be nursing homes. Correctional officers often aren’t equipped with the necessary training, and medical staff can be spread thin. Here at the California Medical Facility, that’s where men like Lyman, Saephanh and Murillo come in. They are part of a cohort of about two dozen men called the Pastoral Care Service Workers. Most of them are convicted murderers serving life sentences who have been granted an unusual role: providing dignified deaths to their fellow inmates.

A job in the hospice is not easy to come by. To qualify, Lyman and the others first have to pass a series of interviews and disciplinary checks and agree to random drug tests. They do 70 hours of preliminary training in the psychological and spiritual dynamics of end-of-life care, bedside etiquette and the bereavement process. But the real education comes with the patients. Keith Knauf, a Presbyterian chaplain who oversees the program, believes that caring for the dying teaches compassion and changes these men in profound ways. Of some 250 workers who have been released from prison since the program began, he says, none has returned for a felony and only three have returned for minor parole offenses. Knauf’s estimates put the program’s recidivism rate at 1.2 percent. Nationally, around 25 percent of federal inmates return to prison within eight years.

Saephanh (left) and Marin.Katy Grannan for The New York Times

Seven days a week, the workers pull 10- to 15-hour shifts, often longer. It’s one of the lowest paid jobs available, making just 15 to 32 cents an hour. They brush patients’ teeth, massage sore limbs, read books out loud, strip soiled mattresses and assist the medical staff. Trust is a rare currency in prison, and some patients whisper conspiracies that the hospice doctors and nurses prioritize the interests of the criminal-justice system over their well-being. The workers can serve as the trusted middlemen between the patients and medical staff. When patients are in their final hours, it is the workers who sit bedside, holding round-the-clock vigils. They pride themselves on their policy: No prisoner here dies alone.

Whether you’re in prison or on the outside, the person being cared for or the caretaker, dying happens in unpredictable ways. Some patients go within hours, like a skeletal man in his 70s who was admitted one morning while I was visiting the unit and zipped into a body bag by sundown. Others the workers get to know well over many weeks. One patient named Lamerrill Dawson had been there for nearly five months, so long that he wondered if he even belonged in the hospice. Known for terrorizing the ward with tantrums, Dawson treated the workers like his personal butlers. He reserved a special kind of torment for Lyman, badgering him with a never-ending list of demands. “Change my diaper, [expletive]!” he was known to holler. “This food is [expletive].”

Marin moving from his wheelchair to his bed for a nap.Katy Grannan for The New York Times

The workers make a point not to find out what the patients have done. They worry that knowing too much could affect the quality of care. When a patient’s past sins cross over into the realm of the horrific, it can be hard to keep creeping judgments and questions at bay. How do you reconcile the dissonance between the serial killer and the elderly patient, bedridden, incontinent and lost in the fog of dementia? The workers are also in prison for crimes, but that doesn’t make them immune to judgment. “Death can be an equalizer,” Lyman said. The past falls aside. Time is grounded in the shifting demands of the body as it begins its decay.

Saephanh is the hospice’s self-appointed barber, and on a sunny, cloudless day, he promised to give Ralph Martinez, a patient with cirrhosis of the liver, a haircut. Martinez sat in a rust-red barber chair outside in the dog run. He tipped his head back and closed his eyes, letting the noon sun graze his sallow skin. Saephanh got to work with the clippers, sending snippets of black hair skittering onto the pavement beneath their feet (the dog run has since been turned into a garden). According to Saephanh, in most other prisons, a Latino would never get a haircut from an Asian barber, or vice versa. Invisible boundaries carve up the cellblocks, and consorting with the “wrong kind,” especially for gang members like Martinez, who belonged to Nuestra Familia, can get you “got.” But within the walls of the hospice, these unspoken rules don’t seem to matter as much. Black men give meal trays to white men with swastika tattoos on their faces, Crips play cards with Bloods and everyone here — regardless of creed, race or politics — gets his hair cut by Saephanh.

Daren Hatfield (left), 49, a hospice worker, and his close friend Leonard Ramsey, 70, a patient.Katy Grannan for The New York Times

Saephanh says he started hospice work because he was looking for redemption. “I’ve done a lot of bad things in the past, and I feel like I can do some good to try and make it right with him. It’s the Christian thing to do.” He grew up in Merced, a nearby city, going to church every Sunday with his five siblings. His father, a landscaper, and his mother, a janitor, emigrated here from the mountains of Laos after the Vietnam War. In eighth grade, Saephanh started hanging around some older cousins who were involved in ganglike activities. He thought they were cool and wanted to be more like them — “drinking, drugs, partying and guns, you know.” Then, at age 17, Saephanh was at a Halloween party, and a brawl broke out. “I’d never seen anybody really die except for the time that I did it, that I shot and killed the guy. Even then I didn’t watch, I just did it, and I left.”

That was 12 years ago. Now, at 29, Saephanh watches people die regularly. His friends give him a hard time about working in the hospice. “They’re like, ‘Aw, man, you’re in there wiping butt!’ ” Saephanh told me. He doesn’t mind much. He keeps looking for small ways to make patients smile and feel a little more comfortable before they go. He spends his wages on ice-cream cones and vending-machine snacks to pass around. He pays special attention to the more isolated patients, like Ernest Marin Jr., an 80-year-old who quickly earned a bad rap in the hospice for stealing from the bunks of others. Saephanh had heard disturbing rumors about the gruesome crime he committed on the outside. He didn’t know if it was true, but he was determined to treat Marin the same way he would any of the others. Having your freedom taken away, having to die in prison, as most here did, with gutting guilt, monolithic regret or the suspicion that the system was rigged against them all along was punishment enough, he believed.

Saephanh gave Marin a gray trucker hat, which he wore every day. When he noticed that Marin’s shoes were falling apart, he asked around to see if anyone had a pair of size 10 sneakers that they might be willing to donate. These gestures caught Marin by surprise. Slowly, he stopped misbehaving as much and started airing out old jokes. By the time I met Marin, he had become the resident comic, spontaneously breaking out into what he called the “boogie-woogie” as he danced in his wheelchair, snapping his dentures in the air like castanets. “He trusts me to make his bed and to go into his area without him there,” Saephanh told me, beaming.

Most of the other workers were just as candid and forthcoming about their pasts — it was what led them to the hospice. Murillo, who is 38, has wavy black hair, an olive-cast complexion and dark-lashed eyes. He was quick to cry, especially when he talked about his life before. Born in Berkeley to young parents who couldn’t provide for him, Murillo stole food and clothes in elementary school to get by. Bullied at school and beaten at home, he began acting out. “It felt better to be viewed as an aggressive individual who was tough, as opposed to a kid who had shame for getting hit at home, for not getting fed, for living in a place that he wasn’t wanted. It was much easier for me to hang around with people who accepted me for being violent.”

Martinez inspecting his beard before shaving.

Katy Grannan for The New York Times

Murillo has been locked up since age 16, more than half of his life, and is serving a life sentence for murder in the second degree. A landmark California law, passed in 2013, allowing juvenile offenders with life sentences the chance to earn parole, gave Murillo hope that he might get out of prison one day. He had a parole hearing a few years ago but received a seven-year denial, meaning that for the time being, his life sentence stands.

Each of the workers has his own style of caregiving, but if there is one trait that stands out about Murillo, it is the tenderness with which he handles the patients. When Jimmy Figueroa needed a shower, Murillo stood in the stall with him to make sure he didn’t fall, fidgeted with the water temperature until it was just right and gently helped towel him off. A few days later, when Ralph Martinez’s health took a sudden turn for the worse and he began sobbing on his bed, it was Murillo who sat down next to him and put an arm around his shoulders. “I’m just returning something I didn’t get as a kid,” Murillo told me, rocking back and forth in his chair, punching his hands together. “All I wanted was kindness and to be held as a boy. Now I get to do that for somebody else. There’s also the regret of not being able to do that for my victims, for the people in my community who I hurt.”

Lyman before getting a shave from Saephanh.Katy Grannan for The New York Times

It took Lyman a while to tell me why he was there. He was shy in a way that could easily be misread as disinterest. Eyes superglued to the ground, slender shoulders tense and hunched, he responded to my questions in as few words as possible. When I asked why he decided to work in the hospice, he told me he didn’t like his previous job in the prison kitchen. Then, in a voice quiet enough that I was forced to crane my neck to hear him, he mumbled, “Also, I had cancer before, so I wanted to work with people who went through something I went through.”

“Me, too,” I said. “Leukemia.”

Lyman’s eyes widened in surprise. “Lymphoma, non-Hodgkin,” he shot back. His shoulders relaxed, and for the first time since we met, he lifted his head and looked me in the eyes.

Figueroa in the chapel at a memorial service for a fellow inmate.Katy Grannan for The New York Times

Lyman grew up in the projects near Compton with a teenage mother and a father who was sentenced to life in prison when he was 5. “I was the kid my mom learned how to raise kids with,” he said. “None of my other siblings got in trouble, just me. I’m the black sheep. I’m my daddy’s son.” Lyman didn’t have what it took to become a rapper, his first career plan. By the time he was 13, he’d become a member of the Compton Crips. He loved everything about gang life — the chaos and girls, the booze and drugs, the tempting of fate each day on the streets — until one afternoon, two weeks after his 18th birthday, he was involved in a shootout with a rival gang in broad daylight. Lyman missed, his gun jamming, but it was too late. A fleet of police cars swerved into view before he could run, the wail of sirens slicing through the residential block. “That’s when I knew it was down, down, baby.” He got 19 years for attempted murder.

In Lyman’s first few weeks at the Los Angeles County Jail, he noticed a lump on his right elbow. He didn’t think anything of it at first. At 18, his body was as strong and fast as ever. But over the course of the next few months, the lump grew to the size of a hard-boiled egg, his already slim frame withered and he began to lose sensation in one hand. After the diagnosis, Lyman was escorted each day by officers to a nearby medical center, where he received radiation treatments while handcuffed to a hospital bed. The hair on his arm singed off, his skin charred to a crisp and he grew so weak that he needed a wheelchair. Lyman didn’t expect to live — wasn’t sure he even wanted to — but after dozens of treatments, the cancer went into remission.

Martinez praying in his cell with Chaplain Keith Knauf.Katy Grannan for The New York Times

It was strange for Lyman to know that without his arrest and the access to medical care that had come with it, he probably wouldn’t be alive. And once he was well, he didn’t know what to make of it all — or what to make of himself. “I was lost. I was ignorant to who I could be.” He married a girl he knew from Compton in a no-fuss ceremony in the visiting yard of the prison and became a father to her two young children. But he was still trying to figure it out.

“Before, I was numb. Death didn’t hold the weight that it should have held.” Now, through his work, he had the opportunity to treat death with respect. “Most people are scared to death of death, but I get the chance to be with people — to impart what I have, and they get to impart what they have,” Lyman said. “It gives me a chance to live.”

It was Lyman whom Lamerrill Dawson asked for when his condition began to worsen. When Dawson became delusional, babbling to imaginary gods, the doctors grew concerned enough to put him on vigil status. Lyman and the other workers took turns sitting by his bedside until Dawson suddenly regained consciousness. “How come I’m on vigil? I want to get up in my wheelchair so that I can breathe!” Dawson threw such a fit that the staff agreed to take him off vigil, and the workers got up to leave.

The next day, when Lyman went to work, he walked straight to the cell in the rear right corner. Dawson lay in bed with eyes wide open. Lyman braced himself for the usual morning’s invective but instead found only silence. He took a step closer. Dawson looked strange, he thought to himself — skin waxen, lips bluish, pupils vacant. Then Lyman noticed the body bag left behind by the nurses. While delivering breakfast trays around the unit, they had been the first to discover his cooling body.

Lyman was upset that Dawson died alone, and even more upset with himself for not pushing harder to stay by his side. But after months of explosive outbursts, everyone had learned it was easier to do as Dawson said. Now, without Dawson there to tell him what to do, Lyman stood, surveying the quiet room. He called Murillo, and they got to work, helping to wash Dawson’s body with a sponge and preparing it for the morgue. When it came time to tie a toe tag onto Dawson’s foot, Lyman felt his throat narrow and tighten. As difficult as Dawson was, he had grown on him over the months. It was moments like those when Lyman was reminded how flimsy the divide between the healthy and the sick really was. None of the workers knew when they might end up here in the hospice — not as worker, but as patient.

The last dusky rays of sun sifted through the shuttered windows of the hospice. Lyman sat in a recliner, taking a break, before starting his second shift of the day. He picked up the silver receiver of a pay phone and pressed it close to his cheek. His son, only 3 at the time, was on the other side.

“What you doing?”

“I’m at work,” Lyman told him.

“You not at work — you in prison,” his son replied with innocent, blunt honesty. Lyman’s face crumpled. He told him he loved him, promised to call back soon and placed the phone back in its cradle.

Within 24 hours, another patient moved into Dawson’s room, and Lyman helped him get settled. The patient taped pictures to the wall — a poster of the ocean in Hawaii where he surfed as a kid, the silhouette of a pinup model torn from a magazine and a photograph of his mother hugging her service dog, a pit bull named Cuddles. Lyman started to clean the room with sanitizing wipes. Before he could finish, he was called next door where another patient had been put on vigil.

Suleika Jaouad wrote the Life, Interrupted column for the New York Times Well section and is the author of the forthcoming memoir “Between Two Kingdoms.”